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Special health care needs of infants born at the limits of viability
Bonnie E Stephens1, Richard Tucker, Betty R Vohr
1Department of Pediatrics and Neonatology, Women and Infants Hospital, 101 Dudley St, Providence, RI 02905, USA. bstephens@wihri.org
Insights
Infants born at the limits of viability have high rates of special health care needs (SHCN). Public insurance was linked to persistent SHCN, highlighting the need for integrated care for high-risk infants.
Area of Science:
- Neonatalogy
- Pediatric Health Services Research
- Developmental Pediatrics
Background:
- Infants born at the limits of viability (22-27 weeks gestation) face significant health challenges.
- Special health care needs (SHCN) are common in this population, impacting long-term outcomes.
- Understanding predictors and persistence of SHCN is crucial for optimizing care.
Purpose of the Study:
- To compare survival and SHCN rates from discharge to 18 months corrected age in extremely preterm infants (22-24 vs. 25-27 weeks).
- To identify predictors of SHCN at discharge and 18 months corrected age.
- To assess the persistence of SHCN in this vulnerable cohort.
Main Methods:
- Retrospective cohort study of 508 infants born between 22 and 27 weeks gestation.
- SHCN defined by need for home oxygen, medication, monitor, gastrostomy tube, or ventriculoperitoneal shunt.
- Statistical analyses included chi-squared tests and regression models to determine predictors and persistence.
Main Results:
- Survival rates were 53% for 22-24 weeks vs. 90% for 25-27 weeks; no 22-week survivors.
- Survivors born at 23-24 weeks had higher rates of SHCN at discharge and 18 months compared to those born at 25-27 weeks.
- Chronic lung disease predicted SHCN at discharge, while public health insurance predicted SHCN at 18 months.
Conclusions:
- High rates of SHCN exist for infants born at the limits of viability, with 40% experiencing persistent SHCN at 18 months.
- Increasing gestational age correlated with decreased SHCN rates.
- The association between public insurance and persistent SHCN underscores the need for comprehensive support services for high-risk infants with combined biological and environmental risks.
Objective:
The objective of this study was to compare rates of survival and special health care needs (SHCN) from discharge to 18 months' corrected age between infants who were born between 22 and 24 weeks and 25 and 27 weeks and to determine predictors and persistence of SHCN.
Methods:
Data were collected on 508 infants who were born between 22 and 27 weeks from January 1, 1998, to December 31, 2002 at Women and Infants Hospital. SHCN was defined as need for home oxygen, medication, monitor, gastrostomy tube, or ventriculoperitoneal shunt. chi(2) was used to compare rates of survival and SHCN between groups. Regression analyses explored predictors of SHCN and their persistence.
Results:
Survival at 22 to 24 weeks was 53% vs 90% at 25 to 27 weeks. There were no 22-week survivors. Survivors at 23 to 24 weeks were more likely to be discharged on oxygen, a monitor, or medications; remain on oxygen or a monitor or require tube feeds at 18 months; and have a SHCN at any time than survivors who were born at 25 to 27 weeks. The strongest predictor of SHCN at discharge was chronic lung disease and at 18 months was public health insurance.
Conclusions:
Rates of SHCN were high for infants who were born at the limits of viability. Although rates decreased with increasing age, 40% had persistent SCHN at 18 months. The association of public health insurance with persistent SHCN indicates a need for comprehensive health care and support services for infants with combined biological and environmental risks.
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